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MGH Lung Transplant ProgramJanuary 5, 2017
!!SSDIMedicare !!!!!A (Inpatient)B (Outpatient)Replacements and supplementsD (prescriptions)MasshealthCo-pay assistanceDentalFundraisingQuestions
!2016 Statistics 16.2 Million People were eligible to enroll in an ACA plan,and 12.7 million people took advantage the uninsured rate has fallen by more than 40 percent for the first time ever, more than 9 in 10 Americans nowhave health insurance In Wisconsin, Gallup recently estimated that the adultuninsured rate in 2015 was 5.9 percent, down from 11.7percent in 2013!Major Changes in 2017 People who are not eligible for subsidies will experiencesteep increases in their premiums Insurers United and Aetna both left the exchange due tolosses
!!!Entitlement based Based on how many quarters you have worked andhow much you earned during that time. After 25 month of disability you will be eligible forMedicare. Periodically reassessed can lose access if conditionimproves.If you think you are eligible and would like toapply you can contact your local social securityofficeIf you need assistance with your application youcan contact https://www.allsup.com/
Deductible DaysCopay DaysLifetime Reserve Days603060 1,316 deductiblePer benefit period 329 co-pay per day 658 co-pay per dayDays replenish after benefit period* concludesDays do not replenishonce used*Benefit Period Begins: Day of an Inpatient AdmissionBenefit Period Ends: 60 Days after day of dischargewww.medicare.gov
PremiumDeductibleCoverage 134.00 18380%MonthlyOne time calendar yearpaymentCan not exhaustMedicare B coveragePremium: 134.00 is the standard amountImmunosuppressant Medications covered at 80%- IF Medicare A was active at the time of transplantMedicare Part D open enrollment- October 15-December 7th-Check your current meds against the 2017 formulary by calling Medicare.Medicare Part D and Medicare Advantage disenrollment period Jan 1- Feb 14www.medicare.gov
!!!!!Will cover services that Medicare A, B and Dcover.Usually have separate out of pocketmaximums for medical and prescriptionscoverage.Prescription coverage is usually similar to PartD coverageAll major insurance companies offer thisplansSometimes offer additional coverage likedental
Even with Medicare medical expenses can stillbe costly! Medicare Supplements will cover only costsleft over after Medicare pays! Offered by most major insurance companies! Have different levels of coverage! In some states (MA included) can deny basedon pre existing conditions if you are under 65! Does not cover any Part D costs
Medicare Part DYour Plan Pays:You Pay: 400 0Phase I:Deductible 400100% aftercopayments listed onright.Generic 42%Brand: 55%Retail:Phase II:Coinsurance / Copayments 400- 3,700Mail Order:Specialty: 33%Phase III:Coverage Gap / Donut Hole 3,700 – Out of Pocket Cost* of 4,95095% or thebalance minus 2.95 or 7.40Phase IV:Catastrophic Coverage 4,951 - remainder of the calendar yearGenerics 51%Brand: 40%5% of the totalcost or 3.30 / 8.25 whicheveris greater
!!!Masshealth now has an open enrollment periodas of 1/1/2017 you are not able to switch outof the MCO you are currently in until nextNovemberManaged Care Options (MCO’s) have limitednetworks so you may not be able to switch yourcare from providers as you were able topreviouslyIf you are a new Masshealth member you aregiven a special enrollment period out side ofthe Nov-Jan window to pick an in network
Program NameIncome LimitPhone #WebsiteNotesSocial Security LowIncome SubsidyIndividual: 1,485Married: icare/prescriptionhelp/MedicareRecipients OnlyAsset Limit: 13,640 (indiv) or 27,250 (married)MassHealthIndividual: 1,367Married: artments/masshealth/MA Residents /insurance/moreprograms/health-safety-net/MA Residents only---------------Must use MGH /Community HealthCenter lthcare/prescriptionadvantage/Health Safety NetPrescriptionAdvantageIndividual: 3,020Married: 4,072MedicareIndividual: 4,904Married: 6,638Non Medicare:Individual: 1,839Married: 2,489MA Residents only
Program tanceProgramsIncome LimitIndividual: 3,923Married: 5,310VariesPhone ation.orgEligible forMedicare Recipientsonly at this time------------Also offerspremium assistancewww.needymeds.orgMany Medicarerecipients noteligible, butexceptions made
!!!MA Health Connector Sells Individual DentalPlansOpen Enrollment Nov 1, 2016 – Jan 31, 2017Costs: Premiums vary from 25 – 55 per month Annual Max of 1,250 in Dental Coverage
Lung transplant coordinatorKristy Farrell-SampsonPhone: 617-726-3582Fax: 617-643-0433Email: kjfarrell-sampson@partners.org
Masshealth ! Co-pay assistance ! Dental ! Fundraising ! Questions ! 2016 Statistics 16.2 Million People were eligible to enroll in an ACA plan, and 12.7 million people took advantage the uninsured rate has fallen by more than 40 percent . Annual Max of 1,250 in Dental Coverage . Lung tra
